Provider Administrative Manual (PAM)


Welcome and thank you for participating in the Trinity Health Plan Of New England network. We appreciate your partnership in delivering high-quality care and better outcomes for our members-your patients. Communication is key to any successful relationship, so we hope you find the contents in this manual helpful and let us know if we can do anything to make working with us easier.

Table of Contents

Section 1: Introduction

Section 2: Eligibility and Enrollment

Section 3: Provider Policies and Protocols

Section 4: Quality Management

Section 5: Utilization Management

Section 6: Case Management

Section 7: Medicare-Covered Drugs

Section 8: Claims Processing Procedures and Guidelines

Section 9: Compliance

Section 10: Special Investigations Unit

Section 11: Network Participation Responsibilities

Section 12: Member Grievance and Appeal Process

Last updated: 06/2024